Choroidal evaluation in patients under alpha-lytic therapy
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CATARACT
Choroidal evaluation in patients under alpha-lytic therapy Maddalena De Bernardo 1
&
Vincenzo Altieri 1 & Alessia Coppola 1 & Marco Gioia 1 & Nicola Rosa 1
Received: 6 April 2020 / Revised: 29 July 2020 / Accepted: 19 August 2020 # The Author(s) 2020
Abstract Purpose To detect any choroidal thickness (CT) change in patients after alpha-lytic drugs withdrawal that could help in the cataract surgery timing decision. Methods Twenty-five eyes of 25 patients (mean age: 76 ± 7 years) under alpha-lytic therapy, and 25 eyes of 25 control subjects (CS) (mean age: 75 ± 7 years) without alpha-lytic therapy, both scheduled for cataract surgery in the fellow eye, were included in this observational, prospective, non-randomized study. All patients underwent EDI-OCT during the first preoperative visit and approximately 1 month (range 28–31 days) after alpha-lytic withdrawal. In the CS group, the OCT during preoperative visit and approximately 1 month after (range 28–31 days) the first examination was performed. Data normality with Kolmogorov-Smirnov test was checked and statistical evaluation with the Wilcoxon-signed rank test was performed. Results The mean subfoveal CT was 224 ± 79.7 μm during therapy and 217 ± 70.4 μm after withdrawal; 1.5 mm nasally from the fovea CT was 198 ± 83.8 μm and 194 ± 82.8 μm, respectively; and 1.5 mm temporally from the fovea CT was 217 ± 55.9 μm and 205 ± 54.4 μm, respectively. A statistically significant reduction (p < 0.05) in all the 3 measured CT points was found. In the CS no significant changes were detected (p > 0.05). Conclusion No severe floppy iris syndrome was detected at the time of surgery. In these patients, CT decrease could be an important sign for cataract surgery timing decision. Keywords Choroidal thickness . IFIS . Cataract surgery . OCT . Alpha-lytic therapy
Introduction Cataract represents the leading cause of blindness worldwide [1]. Today, due to the phacoemulsification techniques and the improvements in intraocular lens (IOL) calculations, cataract surgery is considered one of the most successful procedures in ophthalmology [2]. An adequate pupillary dilatation and the iris stability are among the reasons that make this surgery successful. Sympathetic system, through noradrenaline release, induces radial iris muscle contraction and subsequent pupil dilation (mydriasis). Unfortunately, several drugs, such as selective α1 adrenergic receptor antagonists (ARA) inhibitors, can * Maddalena De Bernardo [email protected] 1
Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, via S. Allende, 84081 Baronissi, Salerno, Italy
complicate cataract surgery, inducing miosis with iris stroma surging and billowing. Even with normal intraocular fluid flows and despite well-constructed wounds, iris could prolapse through surgical incisions. This phenomenon has been described with the name of intraoperative floppy iris syndrome (IFIS) [3]. Ophthalmologists must be aware of IFIS because it is associated with high rates of intraop
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